Oral Diabetes Medications (cont.)

Jim Morelli, MS, RPh

Jim Morelli holds a B.S. from the Massachusetts College of Pharmacy and Allied Health in Boston and an M.S. in civil engineering from Tufts University. He is registered as a pharmacist in the state of Georgia.

Louise Chang, MD

Dr. Chang completed her undergraduate degree at Stanford University and attended medical school at New York Medical College. She completed her internal medicine residency at Saint Vincent's Hospital in New York City, where she also served as a chief resident from 2001-2002. Dr. Chang is board-certified in internal medicine.

What are the warnings and precautions for non-insulin diabetes medications?

Diabetes medications can have interactions with other medications or
supplements being used. Use of more than one diabetes medication can increase
the risk for hypoglycemia. Beta-blocker medications can mask the symptoms of
hypoglycemia.

Sulfonylureasmay increase the risk of death from
cardiovascular disease.
Prolonged exercise and alcohol intake increase the risk for hypoglycemia.
Patients undergoing surgery or who have had recent trauma, stress, or
infection may need to switch from a sulfonylurea to insulin to manage blood
sugar levels. People with kidney or liver disease need to take precaution.

Because meglitinides may cause hypoglycemia, they should be taken right
before meals to minimize the possibility of hypoglycemia. If a meal is to be
skipped, the dose of the medication should also be skipped.

Alpha-glucosidase inhibitors should not be used in people with intestinal
diseases such as inflammatory bowel disease or intestinal obstruction. People
with kidney dysfunction may not be able to these medications.

Alpha-glucosidase inhibitors should be taken with the first bite of each
meal.

Patients with kidney disease may require dosage adjustment if they are using
a DPP-4 inhibitor.

People with a history of liver disease, heavy drinking, or kidney disease may
not be able to take biguanides. Inform medical personnel of biguanide use prior
to any radiological tests which require injection of dye.

Severe hypersensitivity reactions have occurred during use of sitagliptin.

Pramlintide is only appropriate for certain people with diabetes who use
insulin and are having problems maintaining their blood sugar levels. Because of
the potential for severe hypoglycemia with the use of pramlintide is with
insulin, adjustments to insulin dosage and more frequent glucose monitoring may
be necessary. Insulin and pramlintide should not be mixed in the same syringe.

Exenatide may increase the risk of severe even fatal pancreatitis. Byetta
should not be used in people with type 1 diabetes or to treat diabetic
ketoacidosis.

Patients with severe kidney disease or gastrointestinal disease should not
use exenatide.

Hypersensitivity reactions may occur following treatment with exenatide due
to formation of antibodies.